Evolution of Massachusetts physician attitudes, knowledge, and experience regarding the use of antiretrovirals for HIV prevention

The Center for the AIDS Programme of Research in South Africa (CAPRISA) 004 and Pre-exposure Prophylaxis Initiative (iPrEx) studies demonstrated that topical or oral chemoprophylaxis could decrease HIV transmission. Yet to have an appreciable public health impact, physicians will need to be educated about these new HIV prevention modalities. Massachusetts physicians were recruited via e-mail to complete an online survey of their knowledge and use of HIV prevention interventions. Data were collected before (July-December, 2010) (n=178) and after (December, 2010-April, 2011) (n=115) the release of iPrEx data. Over the two time intervals, knowledge of oral PrEP significantly increased (79% to 92%, p<0.01), whereas knowledge about topical microbicides was already high (89% pre-iPrEx). Post-iPrEx, specialists were more knowledgeable about oral PrEP (p<0.01) and topical microbicides (p<0.001) than generalists. The majority of the respondents would prefer to prescribe topical microbicides (75%) than oral PrEP (25%; p<0.001), primarily because they perceived fewer side effects (95%). Respondents indicated that PrEP should be available if it were a highly effective, daily pill; however, ongoing concerns included: potential drug resistance (93%), decreased funds for other forms of HIV prevention (88%), medication side effects (83%), and limited data regarding PrEP's clinical efficacy (75%). Participants indicated that formal CDC guidelines would have the greatest impact on their willingness to prescribe PrEP (96%). Among Massachusetts physicians sampled, chemoprophylaxis knowledge was high, but current experience was limited. Although topical gel was preferred, responses suggest a willingness to adapt practices pending additional efficacy data and further guidance from normative bodies. Educational programs aimed at incorporating antiretroviral chemoprophylaxis into physicians' HIV prevention practices are warranted.     

The Personal Patient Profile-Prostate decision support for men with localized prostate cancer: A multi-center randomized trial

ObjectiveThe purpose of this trial was to compare usual patient education plus the Internet-based Personal Patient Profile-Prostate, vs. usual education alone, on conflict associated with decision making, plus explore time-to-treatment, and treatment choice.MethodsA randomized, multi-center clinical trial was conducted with measures at baseline, 1-, and 6 months. Men with newly diagnosed localized prostate cancer (CaP) who sought consultation at urology, radiation oncology, or multi-disciplinary clinics in 4 geographically-distinct American cities were recruited. Intervention group participants used the Personal Patient Profile-Prostate, a decision support system comprised of customized text and video coaching regarding potential outcomes, influential factors, and communication with care providers. The primary outcome, patient-reported decisional conflict, was evaluated over time using generalized estimating equations to fit generalized linear models. Additional outcomes, time-to-treatment, treatment choice, and program acceptability/usefulness, were explored.ResultsA total of 494 eligible men were randomized (266 intervention; 228 control). The intervention reduced adjusted decisional conflict over time compared with the control group, for the uncertainty score (estimate ?3.61; (confidence interval, ?7.01, 0.22), and values clarity (estimate ?3.57; confidence interval (?5.85,?1.30). Borderline effect was seen for the total decisional conflict score (estimate ?1.75; confidence interval (?3.61,0.11). Time-to-treatment was comparable between groups, while undecided men in the intervention group chose brachytherapy more often than in the control group. Acceptability and usefulness were highly rated.ConclusionThe Personal Patient Profile-Prostate is the first intervention to significantly reduce decisional conflict in a multi-center trial of American men with newly diagnosed localized CaP. Our findings support efficacy of P3P for addressing decision uncertainty and facilitating patient selection of a CaP treatment that is consistent with the patient values and preferences.     

Neural coupling between the arms and legs during rhythmic locomotor-like cycling movement

Neuronal coupling between the arms and legs allowing coordinated rhythmic movement during locomotion is poorly understood. We used the modulation of cutaneous reflexes to probe this neuronal coupling between the arms and legs using a cycling paradigm. Participants performed rhythmic cycling with arms, legs, or arms and legs together. We hypothesized that any contributions from the arms would be functionally linked to locomotion and would thus be phase-dependent. Reflexes were evoked by electrical stimulation of the superficial peroneal nerve at the ankle, and electromyography (EMG) was recorded from muscles in the arms and legs. The main finding was that the relative contribution from the arms and legs was linked to the functional state of the legs. For example, in tibialis anterior, the largest contribution from arm movement [57% variance accounted for (VAF), P < 0.05] was during the leg power phase, whereas the largest from leg movement (71% VAF, P < 0.05) was during leg cycling recovery. Thus the contribution from the arms was functionally gated throughout the locomotor cycle in a manner that appears to support the action of the legs. Additionally, the effect of arm cycling on reflexes in leg muscles when the legs were not moving was relatively minor; full expression of the effect of rhythmic arm movement was only observed when both the arms and legs were moving. Our findings provide experimental support for the interaction of rhythmic arm and leg movement during human locomotion.     

Design of ternary additive for organic photovoltaics: a cautionary tale

Silicon phthalocyanines as ternary additives are a promising way to increase the performance of organic photovoltaics. The miscibility of the additive and the donor polymer plays a significant role in the enhancement of the device performance, therefore, ternary additives can be designed to better interact with the conjugated polymer. We synthesized N-9′-heptadecanyl-2,7-carbazole functionalized SiPc ((CBzPho)₂-SiPc), a ternary additive with increased miscibility in poly[N-90-heptadecanyl-2,7-carbazole-alt-5,5-(4′,7′-di-2-thienyl-2′,1′,3′-benzothiadiazole)] (PCDTBT). The resulting additive was included into PCDTBT and [6,6]-phenyl C₇₁ butyric acid methyl ester as bulk (PC₇₁BM) heterojunction OPV devices as a ternary additive. While the (CBzPho)₂-SiPc demonstrated strong EQE >30% contribution in the range of 650–730 nm, the overall performance was reduced because (CBzPho)₂-SiPc acted as a hole trap due to its high-lying HOMO energy level. This study demonstrates the importance of the solubility, miscibility, and energy level engineering of the ternary additive when designing organic photovoltaic devices.

Silicon phthalocyanines with carbazole axial functional groups were synthesized to improve the miscibility in PCDTBT and for use as ternary additives in organic photovoltaics.     

User and Healthcare Professional Perspectives on Do-It-Yourself Artificial Pancreas Systems: A Need for Guidelines

A growing number of individuals with type 1 diabetes are choosing to use “do-it-yourself” artificial pancreas systems (DIY APS) to support their diabetes self-management. Observational and self-report data of glycemic benefits of DIY APS are promising; however, without rigorous clinical trials or regulation from governing bodies, liability and user safety continue to be central concerns for stakeholders. Despite DIY APS having been used for several years now, there are no guidelines to assist users and healthcare professionals in addressing DIY APS use in routine clinical care. This commentary reports key stakeholders’ perspectives presented at the annual Advanced Technologies and Treatments in Diabetes conference in February 2020. Important considerations to inform the development of clinical care guidelines are also presented to generate further debate.